Health CommitteeWritten evidence from Gilead Sciences (LTC 87)

Executive Summary

Treatment innovation has transformed HIV into a long term condition.

The management of HIV requires special consideration due to its infectious nature.

Ageing in HIV presents significant challenges for the NHS in terms of managing care, complex treatment plans and co-morbidities.

HIV treatments are cost effective because they significantly reduce the risk of onward transmission and HIV related illnesses. However a major threat to the effectiveness of HIV treatment is non-adherence.

New treatments may improve adherence which in turn may ensure patients are healthier, require fewer hospital admissions, and reduce the risk of transmission. All of these outcomes improve value for money for the NHS.

If we do not continue to innovate and invest in HIV, there may be a reversal of the progress we have made so far and an escalation of HIV over time.

Introduction

1. Gilead is a leading provider of HIV medicines to NHS patients. We welcome the opportunity to respond to the Health Select Committee’s inquiry into the management of long term conditions. Our response focuses on the effectiveness of service provision and treatment for people with HIV.

2. HIV treatment has advanced dramatically in the decades since the discovery of the virus. Patient prospects have improved considerably and patients can now expect to have a near normal life expectancy. As patients are living longer with HIV their needs are changing. This means the number of patients and overall costs are rising rapidly.

3. Unlike many other long term conditions, HIV is also infectious. To slow the increase in the number of patients and costs, a two-pronged strategy of early diagnosis and access to treatment is required. Late diagnosis, by contrast, is associated with a greater risk of hospitalisation and AIDS-related illness, reduced life expectancy and increased cost to the NHS. It is also associated with increased onward transmission, and continued sexual risk-taking while people are unaware of their HIV-positive status.

4. Gilead recommends the development of a comprehensive strategy for HIV, that will update current NHS practice in line with the treatments and services patients require today. Further innovation will enable patients to better manage their condition, prolong life expectancy and reduce the risk of transmitting the virus to others.

Ageing and HIV

5. Since 2000 there has been a three-fold increase in the number of individuals accessing HIV care and a fourfold increase among people over the age of 50.1 This presents significant challenges for the NHS in terms of managing care, complex treatment plans and co-morbidities.

6. Current scientific debate on the impact of HIV related premature ageing suggest that we will see an increasing incidence and prevalence of common age related co-morbidities (such as cardiovascular disease, coronary heart disease, chronic kidney disease and cancers). This will require the need for less toxic HIV treatments with fewer drug-drug interactions.

7. The issue of changing patient needs are particularly relevant given the reality of the ageing HIV patient population in the UK over the next five years. Currently many existing medications for common medical conditions have drug interactions, are contraindicated for certain HIV treatments and/or require enhanced diagnostic monitoring.

8. It is important that we develop new HIV treatments that can be safely used alongside medicines for other common medical conditions to protect patients and reduce the strain on the healthcare system.

Adherence to Treatment

9. HIV treatment is highly cost effective, reducing the risk of onward transmission by 96%2 and HIV related illnesses by 41%. However a major threat to the effectiveness of HIV treatment is non-adherence. Adherence to treatment is very important in helping to ensure a positive outcome for patients.3

10. There are a number of factors that inhibit patient adherence to treatment, among them: impact of side effects, fear of disclosure of their HIV status, substance abuse and difficulty in managing multiple tablets.4

11. Missed doses of treatment have been shown to lead to treatment failure,5 increasing both the rate of progression to AIDS6 and the risk of resistance to treatment.7 Non-adherence has been shown to make patients almost twice as likely to require hospital admission.8 .An increase in adherence by just 10% has been shown to reduce the risk of progression to AIDS by 28%.9

12. Given all these factors, supporting full adherence to treatment is a key factor in the long-term affordability of high quality care. New treatments that are easier to manage and have reduced side effects will be important in helping to achieve consistent adherence to maximise virological suppression, improve patients’ quality of life and helping to minimise healthcare resource use.

Conclusion

13. Gilead recommends the development of a comprehensive strategy for HIV, that will update current NHS practice in line with the treatment and services patients require today. The strategy should include the development of appropriate quality measures focused on quality of care and patient experience and choice.

14. In particular, the increasing and ageing population with HIV presents an urgent need for services to be adapted to meet future demand.

15. Patients must continue to have early access to the treatment regimens of their choice and support to remain adherent to treatment plans in order to improve the quality of long-term outcomes, reduce avoidable poor health, minimise the risk of onward transmission and manage costs to the NHS.

13 May 2013

1 HIV in the United Kingdom: 2010 Report, Health Protection Agency, November 2010

2 Cohen, M., Chen, Y., & McCauley, M. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 365(6), 493-505.

3 Glass, T., Geest, S. D., & Hirschel, B; Battegay, M; Furrer, H, Cavassini, M; Vernazza, P; Bernasconi, E; Rickenbach, M; Weber, R; Bucher, H. S. H. C. S. (2008). Self-reported non-adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients. Antiviral Therapy, 13, 77-85.

4 Gazzard, B. G., Anderson, J., Babiker, A., Boffito, M., Brook, G., Brough, G., Churchill, D., et al. (2008). British HIV Association Guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV medicine, 9(8), 563-608.

5 Glass, T., Geest, S.D., & Hirschel, B; Battegay, M; Furrer, H, Cavassini, M; Vernazza, P; Bernasconi, E; Rickenbach, M; Weber, R; Bucher, H.S.H.C.S.(2008). Self-‐reported non-‐adherence to antiretroviral therapy repeatedly assessed by two questions predicts treatment failure in virologically suppressed patients. Antiviral Therapy, 13,77-‐85.

6 Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. a, Roberston, M., Zolopa, a R., & Moss, a. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS (London, England), 15(9), 1181-3.

7 Bangsberg, D. R. (2008). Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. Journal of Infectious Diseases, 197 Suppl(Suppl 3), S272-8.

8 Fielden, S.J., et al., Nonadherence increases the risk of hospitalisation among HIV-infected antiretroviral naïve patients started on HAART, 2008

9 Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. a, Roberston, M., Zolopa, a R., & Moss, a. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS (London, England), 15(9), 1181-3.

Prepared 3rd July 2014